The study by Rosenhan (1973) published in Science
has probably always been difficult to believe. I’ve said before, though, that psychiatry doesn’t need to be so defensive about it (see eg. previous post
). DSM-III was motivated to improve the reliability of psychiatric diagnosis by introducing operational criteria, at least partly due to the challenge of the Rosenhan study, because Robert Spitzer thought unreliable diagnoses must be invalid.
The Rosenhan study was actually more designed to challenge the validity rather than reliability of psychiatric diagnosis. Andrew Scull (who I’ve mentioned before eg. see previous post) has recently published an article in History of Psychiatry summarising the evidence that the study was fraudulent. Six of the seeming nine original participants are said to have never been traced. Data from one of the participants was not included in the Science report and this psychology student at the time of the study, who became an academic psychologist, published his own more positive account of his experience (see article).
At the very least, Rosenhan (1973) is biased, inaccurate, dishonest and exaggerated its findings. As Andrew says, there is a "possibility that they [ie. the six missing participants] may still surface" but he thinks it is more likely they "never existed at all".
I know of two reports of modified repeats of the Rosenhan study. Because they are later, both were done in the context of the rundown of the traditional psychiatric hospital. Although all Rosenhan's pseudopatients were said to have been admitted to hospital, both these reports suggest that feigning an auditory hallucination does not now generally lead to admission, maybe because of the pressure on beds. Scribner (2001) used 7 volunteers with long well documented histories of chronic schizophrenia, six of whom were actually denied treatment and turned away. The baseline histories were therefore very different from Rosenhan (1973), whose pseudopatients were said not to have had a history of mental disorder.
The other report was from the book Opening Skinner's Box (2004) by Lauren Slater. Interestingly, she too has been accused of never conducting her study (see article). As she says in the book in her chapter on Rosenhan:
Psychiatry as a field is, of course, predicated on the belief that its own professionals know how to reliably diagnose aberrant mental conditions and to make judgments based on those diagnoses about a person’s social suitability
Interestingly again, she seems to suggest that Martin Seligman, an eminent psychologist, was one of Rosenhan's pseudopatients, which is not mentioned by Scull (2023). As far as I know, Seligman is still alive, so it may be possible to check this.
Slater herself has a "formidable psychiatric history" and was admitted to a psychiatric hospital aged 14. She does not deny the reality of mental illness. Slater says she used someone else's name, so that she wasn't recognised, and denied any psychiatric involvement in the past. She relates that she presented herself nine times saying she was hearing a voice, and that, although she was treated kindly and was not admitted, she was prescribed a total of 25 antipsychotics and 60 antidepressants. Almost every time she says she was given a diagnosis of psychotic depression.
I suppose Rosenhan could be said to have had more impact on psychiatry as a social scientist than Andrew (except maybe Andrew’s influential dismissal of Foucault in the literature - see eg. previous post)! Not excusing Rosenhan's behaviour, but I think the scientific literature is plagued by such dishonesty as Rosenhan's. There is evidence, though, that at least aspects of his Science paper are correct. Certainly it was possible for a person who is not mentally ill to obtain admission to psychiatric hospital and mislead psychiatrists into diagnosing schizophrenia. Maybe this has always been the main message that people have taken from the study. Rosenhan does seem to have elaborated the details to reinforce his conclusion that psychiatric diagnosis is subjective and does not reflect inherent patient characteristics.
What worries me is that Andrew’s complete dismissal of Rosenhan’s study as fraudulent may reinforce the case that psychiatric diagnosis is objective, which it isn’t in any absolute sense. The limitations of psychiatric diagnosis do need to be acknowledged (see eg. previous post). If psychiatric diagnosis is meaningful, there will be inevitable inconsistencies.